| NPI | 1104009604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY 005210) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 005210) |
| Enumeration Date | 2007-12-07 |
| Last Update Date | 2007-12-07 |